Edward C. Geehr, M.D.

Would you prefer minimally invasive surgery, if it were available?

Many patients who might benefit from minimally invasive, laparoscopic surgery instead of traditional "open surgery" are not given the option, according to a Johns Hopkins University surgeon.

Laparoscopy is a procedure in which a tube is placed through a small cut in your abdomen, near your navel. A tiny video camera (laparoscope) is inserted into the tube and used to see the inside of your pelvis and abdomen. Surgery can be performed with the guidance of the laparoscope and with additional, small incisions.

How much laparoscopy is used varies among hospitals; differences in patients don't account for that variation.

Are you a candidate?

Not all patients are candidates for laparoscopic procedures, which can be limited by widespread cancers or internal scarring. But those conditions represent a small minority of cases. The technique for the remainder of cases results in lower risk of complication rates and greater potential cost savings, according to the Johns Hopkins surgeon and his colleagues.

Surgical complications cost about $25 billion annually; more laparoscopic operations could help to reduce that amount.

What studies say

The findings, published in the journal BMJ (formerly the British Medical Journal), are based on an examination of data from four common procedures: appendectomy (appendix removal), hysterectomy (removal of the uterus), colectomy (removal of all or part of the colon) and lung lobectomy (removal of part of the lung), at more than 1,000 hospitals.

The Johns Hopkins researchers found the risk of complications was substantially lower for laparoscopy than for all four procedures. The risk was one-third less for colectomy and more than halved for appendectomies.

It's become increasingly popular to perform appendectomy via laparoscopy, due to the more rapid recovery time. However, only one-third of U.S. hospitals use the minimally invasive approach often. One-third of hospitals use the open method a majority of the time and one-third use a roughly equal mix of the two procedures.

How the studies were conducted

To measure the use of each procedure, the Johns Hopkins researchers collected data from a large inpatient database that contains information on more than 7 million admissions. All 1,051 hospitals included in the data had similar patient characteristics for the four procedures. So, differences in patient condition didn't explain the varying numbers of minimally invasive versus open procedures observed between hospitals.

For appendectomy, researchers estimated that 71% of patients could have had their appendix removed by laparoscopy, but one-third of hospitals used the open procedure instead for the majority of cases. Minimally invasive surgery was more likely to be performed in large, urban teaching hospitals located in the Midwest, South or West.

Differences between hospitals are believed to reflect differences in their institutions' culture and surgeon training in minimally invasive techniques. A 2009 survey of Canadian surgeons found that lack of training was the main reason surgeons preferred to use the open procedure.

For patients who are to undergo surgery for appendectomy, hysterectomy or colectomy, I recommend that you ask your surgeon if you are a candidate for minimally invasive surgery and if he or she routinely performs that procedure.

If you are a candidate, but an open approach is still recommended, get a second opinion. For lung lobectomy candidates, the effectiveness and safety of the laparoscopic versus open approach are less clear cut. So it's important to discuss with your surgeon the merits of each procedure and his or her experience with minimal versus open techniques.